Are the health systems of EU countries hosting Ukrainian refugees ready to adapt?
Authors: Paul B Spiegel
Journal: The Lancet Healthy Longevity (2022)

The war in Ukraine and its direct and indirect consequences have reverberated throughout the world. The media report on the horrific consequences that are occurring daily, mostly through personal stories that attempt to encapsulate the horrors of this unprovoked war by Russia. Until this issue in The Lancet Healthy Longevity, to my knowledge there have been no peer-reviewed articles with large-scale quantitative data that analyse the health situation for Ukrainian refugees and their potential effects on health systems. When I was the Emergency Coordinator for the Ukraine refugee response for WHO in March and April of this year, I noted that this absence of available health data from EU hosting countries made planning and response extremely difficult for the multitude of actors involved in the Ukrainian refugee crisis.1Spiegel PB Responding to the Ukraine refugee health crisis in the EU.Lancet. 2022; 399: 2084-2086Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar Until now, the data collected and shared on Ukrainian refugees by the EU-refugee hosting governments remain inadequate for an effective response and for future planning.In their Article2Piotrowicz K Semeniv S Kupis R et al.Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records data.Lancet Healthy Longev. 2022; (published online Sept 16.)https://doi.org/10.1016/S2666-7568(22)00187-8Summary Full Text Full Text PDF PubMed Google Scholar in The Lancet Healthy Longevity, Piotrowicz and colleagues attempt to partly address this issue by using public data to focus on pension-age Ukrainian refugees, who constitute the largest burden on the Polish health-care system among the Ukrainian refugees. The authors analysed various datasets from Ukraine and Poland to estimate the absolute numbers of older refugees with specific diseases and predict the number of new cases that will develop. The authors estimated that approximately 624 690 older people (nearly 10% of the total number of Ukrainian refugees in Poland), predominantly female, have a substantial burden of cardovascular, pulmonary, gastrointestinal, and genitourinary disease, as well as infectious diseases, that will affect the Polish health-care system.The authors discussed the Polish health system and the challenges that such a large influx of older people will have if the system does not adapt in an innovative and flexible manner. These challenges are not unique to Poland and apply to most of the other countries hosting a large number of Ukrainians relative to the country's population size. These challenges include an insufficient number of general physicians who typically act as the gateway to the health-care system, the need to train health-care workers about diseases they might not typically see among nationals in such large numbers or severity (eg, tuberculosis and mental health illnesses), a remuneration system that does not allow health-care professionals to be reimbursed in an administratively simple manner, increased demand on tertiary care (eg, oncological cases), an inadequate amount of health information and guidance translated into Ukrainian, and an insufficient provision of interpreters.2Piotrowicz K Semeniv S Kupis R et al.Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records data.Lancet Healthy Longev. 2022; (published online Sept 16.)https://doi.org/10.1016/S2666-7568(22)00187-8Summary Full Text Full Text PDF PubMed Google ScholarFinally, the authors provide concrete numbers that allow health-care planners to understand tangibly the challenges to their systems and plan accordingly. For example, the estimated number of approximately 1500 new myocardial infarctions per year is the equivalent to the turnover of one full-scale invasive cardiology centre, and estimations suggest there will be about 20 000 new strokes annually. There will be approximately 4500 new and recurring cases of tuberculosis per year, which indicates that active tuberculosis screening during each medical contact is advisable.2Piotrowicz K Semeniv S Kupis R et al.Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records data.Lancet Healthy Longev. 2022; (published online Sept 16.)https://doi.org/10.1016/S2666-7568(22)00187-8Summary Full Text Full Text PDF PubMed Google ScholarHave EU countries hosting large numbers of Ukrainian refugees planned for, and adapted their health systems to adjust to, this new reality? From early in the crisis until now, there has been a plethora of guidance and advice from WHO, practitioners, and academics about what needs to be done.1Spiegel PB Responding to the Ukraine refugee health crisis in the EU.Lancet. 2022; 399: 2084-2086Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 3Jaeger FN Berger C Buettcher M et al.Paediatric refugees from Ukraine: guidance for health care providers.Swiss Med Wkly. 2022; 152w30200PubMed Google Scholar, 4Rahimi F Talebi Bezmin Abadi A The Ukrainian refugee crisis and the COVID-19 pandemic in Europe.Int J Surg. 2022; 102106671Crossref Scopus (3) Google Scholar, 5Kamenshchikova A Margineau I Munir S et al.Health-care provision for displaced populations arriving from Ukraine.Lancet Infect Dis. 2022; 22: 757-759Summary Full Text Full Text PDF PubMed Google Scholar, 6Murphy A Fuhr D Roberts B Jarvis CI Tarasenko A McKee M The health needs of refugees from Ukraine.BMJ. 2022; 377: o864Crossref PubMed Scopus (9) Google Scholar, 7Kaufman KR Bhui K Katona C Mental health responses in countries hosting refugees from Ukraine.BJPsych Open. 2022; 8: 1-10Crossref Scopus (4) Google Scholar, 8WHORegional Office for EuropeUkraine crisis strategic response plan for June–December 2022.https://apps.who.int/iris/handle/10665/358796Date: 2022Date accessed: August 29, 2022Google Scholar, 9WHOUkraine crisis: public health situation analysis—refugee-hosting countries.https://apps.who.int/iris/bitstream/handle/10665/352494/WHO-EURO-2022--5169--44932--63918-eng.pdf?sequence=3&isAllowed=yDate: March 17, 2022Date accessed: August 29, 2022Google Scholar Beyond health-care issues for older Ukrainian refugees, issues of vaccination, maternal and child health, mental health, outbreak response, and health information systems are only some aspects that need to be comprehensively addressed. However, published health strategies from ministries of health for most EU countries, which contain specific numbers and the potential effects on health systems of hosting large numbers of Ukrainian refugees, do not exist or, at least, have not been publicly shared.A robust, timely, and comprehensive health-information system that includes early warnings and outbreak responses that are disaggregated by nationality and connect the community-based non-governmental organisations with the more formal health-care system and insurance providers needs to be established. This information can be supplemented by data from social media, mobile(cell) phones, and crowd-sourcing in a manner that respects data privacy. Together, these data could enable governments and their partners to create an evidence-based health strategic plan that takes into account other sectors, such as education, water and sanitation, and the environment. As with the COVID-19 pandemic, the Ukrainian refugee crisis has shown some of the fragility and inflexibility of the public health and curative health systems in some of these EU countries. Funding coming from the EU, together with other sources, could also be used to improve the future of health systems for these countries hosting refugees. Funding could also be used to develop innovative and forward-looking digitalised health-data systems that communicate with the various levels of the system in a seamless manner to make health systems and services increasingly efficient and effective. Health passports that allow patients autonomy and access to their health-care data in a secure manner could also be created to provide patients with access to and ownership of their data and improve continuity of care, now and for any future movement or displacement.With all crises, opportunities arise to improve existing systems and services. Piotrowicz and colleagues have examined public data and brought to light some clear challenges to the Polish health system that can be addressed. I hope that the EU governments will use these data, and other data that will surely be produced in the future, to publish evidence-based health-system strategies that will immediately benefit all the refugees within their countries (and not just Ukrainians), and take advantage of this opportunity to improve their systems for the future benefit of their citizens. The war in Ukraine and its direct and indirect consequences have reverberated throughout the world. The media report on the horrific consequences that are occurring daily, mostly through personal stories that attempt to encapsulate the horrors of this unprovoked war by Russia. Until this issue in The Lancet Healthy Longevity, to my knowledge there have been no peer-reviewed articles with large-scale quantitative data that analyse the health situation for Ukrainian refugees and their potential effects on health systems. When I was the Emergency Coordinator for the Ukraine refugee response for WHO in March and April of this year, I noted that this absence of available health data from EU hosting countries made planning and response extremely difficult for the multitude of actors involved in the Ukrainian refugee crisis.1Spiegel PB Responding to the Ukraine refugee health crisis in the EU.Lancet. 2022; 399: 2084-2086Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar Until now, the data collected and shared on Ukrainian refugees by the EU-refugee hosting governments remain inadequate for an effective response and for future planning. In their Article2Piotrowicz K Semeniv S Kupis R et al.Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records data.Lancet Healthy Longev. 2022; (published online Sept 16.)https://doi.org/10.1016/S2666-7568(22)00187-8Summary Full Text Full Text PDF PubMed Google Scholar in The Lancet Healthy Longevity, Piotrowicz and colleagues attempt to partly address this issue by using public data to focus on pension-age Ukrainian refugees, who constitute the largest burden on the Polish health-care system among the Ukrainian refugees. The authors analysed various datasets from Ukraine and Poland to estimate the absolute numbers of older refugees with specific diseases and predict the number of new cases that will develop. The authors estimated that approximately 624 690 older people (nearly 10% of the total number of Ukrainian refugees in Poland), predominantly female, have a substantial burden of cardovascular, pulmonary, gastrointestinal, and genitourinary disease, as well as infectious diseases, that will affect the Polish health-care system. The authors discussed the Polish health system and the challenges that such a large influx of older people will have if the system does not adapt in an innovative and flexible manner. These challenges are not unique to Poland and apply to most of the other countries hosting a large number of Ukrainians relative to the country's population size. These challenges include an insufficient number of general physicians who typically act as the gateway to the health-care system, the need to train health-care workers about diseases they might not typically see among nationals in such large numbers or severity (eg, tuberculosis and mental health illnesses), a remuneration system that does not allow health-care professionals to be reimbursed in an administratively simple manner, increased demand on tertiary care (eg, oncological cases), an inadequate amount of health information and guidance translated into Ukrainian, and an insufficient provision of interpreters.2Piotrowicz K Semeniv S Kupis R et al.Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records data.Lancet Healthy Longev. 2022; (published online Sept 16.)https://doi.org/10.1016/S2666-7568(22)00187-8Summary Full Text Full Text PDF PubMed Google Scholar Finally, the authors provide concrete numbers that allow health-care planners to understand tangibly the challenges to their systems and plan accordingly. For example, the estimated number of approximately 1500 new myocardial infarctions per year is the equivalent to the turnover of one full-scale invasive cardiology centre, and estimations suggest there will be about 20 000 new strokes annually. There will be approximately 4500 new and recurring cases of tuberculosis per year, which indicates that active tuberculosis screening during each medical contact is advisable.2Piotrowicz K Semeniv S Kupis R et al.Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records data.Lancet Healthy Longev. 2022; (published online Sept 16.)https://doi.org/10.1016/S2666-7568(22)00187-8Summary Full Text Full Text PDF PubMed Google Scholar Have EU countries hosting large numbers of Ukrainian refugees planned for, and adapted their health systems to adjust to, this new reality? From early in the crisis until now, there has been a plethora of guidance and advice from WHO, practitioners, and academics about what needs to be done.1Spiegel PB Responding to the Ukraine refugee health crisis in the EU.Lancet. 2022; 399: 2084-2086Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 3Jaeger FN Berger C Buettcher M et al.Paediatric refugees from Ukraine: guidance for health care providers.Swiss Med Wkly. 2022; 152w30200PubMed Google Scholar, 4Rahimi F Talebi Bezmin Abadi A The Ukrainian refugee crisis and the COVID-19 pandemic in Europe.Int J Surg. 2022; 102106671Crossref Scopus (3) Google Scholar, 5Kamenshchikova A Margineau I Munir S et al.Health-care provision for displaced populations arriving from Ukraine.Lancet Infect Dis. 2022; 22: 757-759Summary Full Text Full Text PDF PubMed Google Scholar, 6Murphy A Fuhr D Roberts B Jarvis CI Tarasenko A McKee M The health needs of refugees from Ukraine.BMJ. 2022; 377: o864Crossref PubMed Scopus (9) Google Scholar, 7Kaufman KR Bhui K Katona C Mental health responses in countries hosting refugees from Ukraine.BJPsych Open. 2022; 8: 1-10Crossref Scopus (4) Google Scholar, 8WHORegional Office for EuropeUkraine crisis strategic response plan for June–December 2022.https://apps.who.int/iris/handle/10665/358796Date: 2022Date accessed: August 29, 2022Google Scholar, 9WHOUkraine crisis: public health situation analysis—refugee-hosting countries.https://apps.who.int/iris/bitstream/handle/10665/352494/WHO-EURO-2022--5169--44932--63918-eng.pdf?sequence=3&isAllowed=yDate: March 17, 2022Date accessed: August 29, 2022Google Scholar Beyond health-care issues for older Ukrainian refugees, issues of vaccination, maternal and child health, mental health, outbreak response, and health information systems are only some aspects that need to be comprehensively addressed. However, published health strategies from ministries of health for most EU countries, which contain specific numbers and the potential effects on health systems of hosting large numbers of Ukrainian refugees, do not exist or, at least, have not been publicly shared. A robust, timely, and comprehensive health-information system that includes early warnings and outbreak responses that are disaggregated by nationality and connect the community-based non-governmental organisations with the more formal health-care system and insurance providers needs to be established. This information can be supplemented by data from social media, mobile(cell) phones, and crowd-sourcing in a manner that respects data privacy. Together, these data could enable governments and their partners to create an evidence-based health strategic plan that takes into account other sectors, such as education, water and sanitation, and the environment. As with the COVID-19 pandemic, the Ukrainian refugee crisis has shown some of the fragility and inflexibility of the public health and curative health systems in some of these EU countries. Funding coming from the EU, together with other sources, could also be used to improve the future of health systems for these countries hosting refugees. Funding could also be used to develop innovative and forward-looking digitalised health-data systems that communicate with the various levels of the system in a seamless manner to make health systems and services increasingly efficient and effective. Health passports that allow patients autonomy and access to their health-care data in a secure manner could also be created to provide patients with access to and ownership of their data and improve continuity of care, now and for any future movement or displacement. With all crises, opportunities arise to improve existing systems and services. Piotrowicz and colleagues have examined public data and brought to light some clear challenges to the Polish health system that can be addressed. I hope that the EU governments will use these data, and other data that will surely be produced in the future, to publish evidence-based health-system strategies that will immediately benefit all the refugees within their countries (and not just Ukrainians), and take advantage of this opportunity to improve their systems for the future benefit of their citizens. I declare no competing interests. Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records dataOur data indicate that the disease burden of older Ukrainian refugees is considerable. Although our estimates are only approximations, they provide a basis for predicting which areas of health care will most need to be reinforced to meet the challenge of the potential financial and logistical impacts on receiving countries. Full-Text PDF Open Access